(CNN) — A record share of kindergartners in the United States had an exemption for a required vaccination last school year, as the Trump administration continues to make moves to reduce the number of vaccinations recommended for children.
An executive order signed by President Donald Trump last week aims to reshape the federal government’s approach to vaccines. The order offers recommendations to “give parents more information and options” — but the authority to set and enforce vaccine requirements still lies with states, and a growing share are utilizing existing policies that allow exemptions.
The administration signaled that it will push states to rework their vaccine requirements to incorporate the new federal guidelines, effectively upending longstanding practices aimed at improving childhood immunization rates. It’s unclear exactly how officials plan to reinforce this, but the Department of Justice, the Department of Education and the Department of Health and Human Services have been directed to tie compliance with federal funding.
The new executive order emphasizes the administration’s aim to “maximize parental choices over vaccinations for their children,” specifically noting that states should “provide religious and medical exemptions” to vaccine requirements.
All 50 states have their own laws requiring certain vaccines for students to attend school, and all allow students to be exempted from school vaccine requirements for medical reasons. The vast majority of states also allow vaccine exemptions for non-medical reasons, which may be categorized as religious or personal.
Utilization of these exemptions is more common than it’s ever been. Data published Monday by the US Centers for Disease Control and Prevention shows that 4.2% of kindergartners had an exemption for at least one required vaccine during the 2025-26 school year.
This left about 157,000 new schoolchildren without full coverage for at least one state-mandated vaccine last school year, CDC data shows – nearly 20,000 more than the year before.
The share of students with a vaccine exemption is the highest on record and twice as high as it was a decade ago. Last school year, only 0.2% of exemptions were for medical reasons, a share that has held steady for years.
Exemptions increased in all but nine states, and nearly half of states report exemptions exceeding 5%, according to the CDC.
According to the National Conference of State Legislatures, only four states do not allow exemptions that are not for medical reasons: California, Connecticut, Maine and New York.
New York removed the option for religious exemptions for school vaccines in 2019 after measles outbreaks in the state grew to some of the largest the US had seen in decades.
The new CDC data shows that the measles-mumps-rubella (MMR) vaccination rate among kindergartners fell only slightly last school year, from 92.5% to 92.4%, but that’s still well below the 95% coverage needed to provide herd immunity and prevent outbreaks.
State authority to set vaccine policy has been challenged before but broadly upheld by the US Supreme Court.
States are still reviewing the new executive order, but many – including those that follow federal guidance for vaccine policy and those that have broken from federal recommendations – say that it does not require any changes at the state level.
“Federal recommendations do not change the requirements in Texas,” the state health department said in an email to CNN.
Others responded to the president’s action with a commitment to science-based vaccine policy.
“Vaccines are our most effective defense against vaccine-preventable illnesses,” Dr. Puthiery Va, director of the Maine Center for Disease Control and Prevention, said in a statement. “In Maine, vaccines remain available at no cost to eligible children through the Maine CDC’s Immunization Program. Maine’s school and child care immunization requirements remain unchanged by federal actions to date.”
Changes to any state vaccine exemption laws would need to be passed by state legislatures, many of which will not meet again until January.
But courts can get involved, too. Mississippi started allowing religious exemptions in 2023 after a federal court order, and a move to allow religious exemptions in West Virginia is facing legal challenges. Before these changes, both states were known to have exceptionally high childhood vaccination coverage under some of the strictest laws.
Public health experts say that building trust in the safety and effectiveness of vaccines is key to reversing the decline in childhood immunization rates.
“If more and more parents choose not to vaccinate their children for non-medical reasons, we will no doubt see a rise in disease outbreaks,” Dr. William Moss, an associate professor with Johns Hopkins Bloomberg School of Public Health, has said.
Measles cases in the US have reached a 35-year-high this year, the vast majority of which are in people who have not been vaccinated with the MMR.
But the new executive order advises that the MMR be separated into three individual shots — a dramatic change that goes against broad scientific consensus and a suggestion that could raise doubts.
States have typically aligned their policies for vaccine requirements with recommendations from the CDC and its Advisory Committee on Immunization Practices (ACIP). But ACIP has undergone sweeping changes under US Department of Health and Human Services Secretary Robert F. Kennedy Jr., and actions by the federal agency and the advisory board to overhaul the childhood vaccine schedule — including a reduction in the number of diseases covered by routine vaccinations — have led many states to break from this longstanding practice.
According to KFF, 28 states have announced that they will no longer follow federal vaccine recommendations. Most have indicated that they will instead follow recommendations from the American Academy of Pediatrics, an independent medical association.
“For decades, the U.S. childhood immunization schedule was developed through a rigorous scientific process required by law that evaluates the safety and effectiveness of vaccines and how they should be given to patients. This transparent, expert-led process has helped prevent serious diseases, reduce hospitalizations, and save millions of lives,” the Governors Public Health Alliance said in a statement. The coalition includes more than a dozen governors who represent about a third of the US population.
“President Trump’s Executive Order directing changes to longstanding federal vaccine recommendations circumvents that process and defies scientific consensus. It also risks causing confusion and endangering our children,” the alliance said.
“Parents should know that vaccines currently available in the United States remain available and that the Executive Order does not change that. Governors and state public health leaders hold the power to continue working with healthcare providers, schools, and local health agencies to ensure that parents have access to trusted information and can make informed decisions regarding the health of their children.”
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